Tom Joyce
Analyst · JPMorgan
Thanks, Doug. First, in terms of North America, North America has historically been, going all the way back to when we acquired Beckman, the most challenging market for us. That business was in decline in North America when we acquired the business. We track the – our retention of customers and our win rates very closely in each one of the markets. And we’ve been very encouraged by the progress that we’ve made in North America associated with retention and with new customer win rates. Our strength has typically come from our core businesses around immunoassay and clinical chemistry with the addition of Iris in urinalysis, an acquisition we did following Beckman, as well as the microbiology business, we’ve strengthened our offering in North America now. As I mentioned relative to, I think, Tycho’s question earlier, the challenge has really been around hematology. And that’s where our retention and our win rates have been the most challenged. And that’s where we’ve put a great deal of energy and investment associated with new product development to better position ourselves for improved competitiveness in North America. So that’s the way I’d probably characterize it. I think you’re on the right track in terms of that particular geography being one of our biggest opportunities for improvement. And I think we’re making progress there. Relative to PAMA, Doug, we’ve seen very little impact of PAMA to this point. Certainly, we’ve had some dialogue about PAMA with a number of key customers. I think they understand well the impact that PAMA has, at least associated with a fairly narrow segment of our business. Remember, I guess, for others on the call, PAMA impacts only U.S. businesses, U.S. Diagnostic businesses. Only 40% of our Diagnostic business at Beckman is in the U.S. And of that business in the U.S., 75% of it is in the hospital. And PAMA, the cuts in reimbursement associated with PAMA, are associated with generally outpatient testing. And so the impact has been fairly modest at this point. We expect those – the dialogue around PAMA to continue this year associated with the contract renewals. But we think we understand what that modest impact might look like and are managing to that accordingly. And then in terms of the flu impact across the overall market, we didn’t see the higher level of spend associated with flu, Doug, as having any negative impact on the rest of our sell in to our end users. So in general, we saw that flu as largely incremental, driven by obviously the challenging nature of the season itself but also associated with our good execution associated with new customer penetration and new test menu.